California Workers' Compensation Training - ABD Insurance PDF
Preview California Workers' Compensation Training - ABD Insurance
ABD Webinar Series California Workers’ Compensation Training WC-101 April 22, 2014 WORKERS' COMPENSATION TRAINING 101 Welcome ABD Workers’ Compensation & Disability Team Robin Hendrickson SVP, Risk Control and Claims Michael Okamura AVP, WC Claims Consultant Tyler Jones Risk Control and Claims Specialist WORKERS' COMPENSATION TRAINING 101 2 Agenda • Workers’ Compensation Overview • What is a work related injury/illness/What is not • Red Flags and potential defenses • Knowledge of injury/illness • Classification of Claims • WC Benefits • Types of Claim Settlements • Roles & Responsibilities • Medical Providers • Return to Work/Transitional work duty • Accident Investigation • WC required posters, notifications and claim forms • Workers’ Compensation Workflow • Resources • Upcoming WC webinars • Open for Questions WORKERS' COMPENSATION TRAINING 101 3 Workers’ Compensation Overview • Benefits include: Employer paid benefit: • Medical Care • Insurance policy from a • Temporary disability/lost wages licensed insurance carrier • Permanent disability payments authorized to write WC • Job displacement voucher policies in California, or • Death payments • Self insured plan, upon • Benefit levels determined state approval by the state Claims Administration • Limited to work related injury, illness or death • Insurance carrier’s claims department • No fault system/Exclusive Remedy • Third Party Administrator • Employee relinquishes the right to sue the employer in • Self Insured/Internal exchange for a specified set claims department of benefits WORKERS' COMPENSATION TRAINING 101 4 Workers’ Compensation • Provides WC coverage • Receives benefits • Reports injuries/illness • Participates in medical treatment, claim • Engaged through out EMPLOYER EMPLOYEE process and return life of claim to work program ADDITIONAL BROKER • Medical Provider • ABD provides client PARTIES INSURANCE services and • Nurses COMPANY advocacy • Investigator • Carrier or TPA • Attorneys administers the claims WORKERS' COMPENSATION TRAINING 101 5 Average cost of a WC claim: $87,000 Medical – 60% Indemnity – 40% Prescription Drugs Physician dispensed RX average cost per claim increased over 50% Narcotics account for 25% of drug costs “Sometimes the walk to the doctors’ office is a better cure than the medicine you receive.” – Benny Bellamacina WCIRB Report on 12/31/2013 Insurer Experience NCCI Research Brief/Workers’ Compensation Drug Study:2013 Update WORKERS' COMPENSATION TRAINING 101 6 What is a work related injury/illness? The injury or illness must arise out of employment (AOE) and occur during the course of employment (COE) Examples (on-the-job): • Cumulative trauma injury caused by repetitive keyboarding (RSI/musculoskeletal) • A broken arm from falling off a ladder • Lower back strain from lifting a box or prolonged seating • Hearing loss due to ongoing exposure to excessive noise levels WORKERS' COMPENSATION TRAINING 101 7 Ouch... Cumulative injury claims have increased 25% since 2010 WCIRB Analysis of Changes in Indemnity Claim Frequency, 12/23/2013 Report WORKERS' COMPENSATION TRAINING 101 8 Less recognized work related injuries • Special errand or assignment carried out at employer’s direction • Business trips • Employer furnished or employer required transportation • Mandatory attendance at company sponsored events • Lunch and break time accidents occurring on the employer’s premises WORKERS' COMPENSATION TRAINING 101 9 Not related work injury? Injuries & Illnesses usually not considered work related include: • Post termination or after notice of lay-off • Ordinary commute to or from work (going and coming rule) • Off-duty recreational activity • Injuries caused by intoxication or drugs (medical evidence by physician) WORKERS' COMPENSATION TRAINING 101 10
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